不同髋臼杯前倾位置和球头假体大小对全髋关节置换术后后方稳定性的影响

目的探讨髋臼杯的前倾位置与球头大小对全髋关节置换（THA）术后后方稳定性的影响。方法利用计算机导航技术在假骨上模拟THA术后,不同髋臼杯前倾位置和不同球头大小在屈髋90°、内收0°和内收30°时髋关节内旋到引起脱位的角度进行测量和比较发生后脱位时的角度差异。结果在髋臼杯外展45°、前倾0°、5°、10°、15°时,28mm和36mm球头在屈髋90°内收0°和30°睛况下内旋至脱位的角度有明显差别（均为P〈0．05）,36mm球头可有更大的内旋角度,稳定性优于28mm球头。但当髋臼杯前倾20°时28mm与36mm球头内旋至脱位的角度间的差异无统计学意义（P〉0．05）,内收30°时比内收0°时髋关节内旋至脱位的角度减小。关节稳定性随髋臼杯前倾减小而下降。髋臼杯前倾0°和髋关节内收30°时,28mm球头在外旋位时就可发生脱位。结论髋臼杯前倾角度增加可增加THA术后关节的稳定性,大球头的稳定性优于小球头,前倾达到某一角度时,大球头和小球头间的后方稳定性无差别。     

开放复位加股骨短缩术治疗小儿发育性髋关节脱位的临床研究

目的探讨开放复位加股骨短缩术治疗小儿发育性髋关节脱位（DDH）的临床疗效。方法回顾性分析本组11例（11髋）DDH患儿采用开放复位、股骨短缩术加Salter截骨术式治疗。其中男2例,女9例;左侧7例,右侧4例。患儿手术时年龄为2岁8个月～5岁3个月,平均3．5岁。按Tsnnis系统分级：Ⅲ度2例,Ⅳ度9例。术前患肢缩短1．5～3．5cm,平均2．4cm。结果患儿随访时间1～6年,平均2．8年。股骨颈前倾角术前测量30°～50°,术中皆矫正至20°左右。术前髋臼指数35°～55°,术后矫正至17°～32°。术中股骨截骨长度1．0～2．5cm,平均1．6cm。McKay评分,优7髋,良4髋。股骨头缺血性坏死1例。结论对2～6岁之间的高脱位DDH患儿,开放复位术中发现复位困难或复位后压应力大时应行股骨截骨短缩术。     

Fatty marrow conversion of the proximal femoral metaphysis in transient bone marrow edema syndrome

Introduction In the proximal femoral metaphysis, hematopoietic marrow is predominant during the adult stage of life. The conversion of hematopoietic marrow to fatty marrow in the proximal femoral metaphysis has been suggested as an etiologic factor of ischemia in the pathogenesis of femoral head osteonecrosis. To determine whether the chronology of fatty marrow conversion of the proximal femoral metaphysis is related to transient bone marrow edema syndrome of the hip, a case control study was conducted on 10 patients with the disease.Materials and methods There were 8 men and 2 women with a mean age of 33 years (range 19–45 years). The 10 patients were matched with 20 controls for gender and age (5-year range). T1-weighted MRI scans of their hips were reviewed. Marrow of the greater trochanter becomes fatty before puberty, and thus, the greater trochanter can be used as a built-in control. The signal intensity of the proximal femoral metaphysis was compared to that of the greater trochanter.Results In all patients, the signal intensity of the proximal femoral metaphysis was isointense (fatty marrow) relative to that of the greater trochanter. In control subjects, the signal intensity was isointense in 8 (40%) and hypointense (hematopoietic marrow) in 12 (60%) (p<0.05).Conclusion The current study shows that the proximal femoral metaphysis is predominantly fatty in transient bone marrow edema syndrome. The conversion of hematopoietic to fatty marrow is known to correlate with decreases in intramedullary blood flow. Thus, the current study suggests that an ischemia of the proximal femur secondary to fatty marrow conversion of the proximal femoral metaphysis might be a cause of transient bone marrow edema syndrome of the hip.     

The aluminum content of bone increases with age, but is not higher in hip fracture cases with and without dementia compared to controls

Aluminum is considered a potentially toxic metal, and aluminum poisoning may lead to three types of disorders: aluminum-induced bone disease, microcytic anemia and encephalopathy. This is well known in patients with chronic renal failure, but since healthy subjects with normal renal function retain 4% of the aluminum consumed, they are also at risk of long-term low-grade aluminum intoxication. Included in this study were a total of 172 patients (age range 16–98 years) with the aim of examining whether aluminum accumulates in bone with increasing age. Additionally, we aimed to investigate whether the aluminum content of bone differs between controls and hip fracture cases with and without dementia, in particular in those with Alzheimers disease. During operations for all cases, bone biopsies were taken with an aluminum-free instrument from the trabecular bone. The samples were measured for their content of aluminum using an inductively coupled mass spectrometer. We found an exponential increase in aluminum content of bone with age. The average aluminum values, adjusted for age, were similar in men and women (P=0.46). No significant differences in sex- and age-adjusted mean aluminum values between the controls and the hip fracture cases with (P=0.72) and without (P=0.33) dementia could be detected. The average aluminum concentration among cases with Alzheimers disease was also similar to the values of hip fracture patients with other types of dementia (P=0.47). Odds ratios of hip fracture for each quartile of aluminum content in bone were also estimated to detect non-linear effects, but we did not find any statistically significant association remaining after age and sex adjustment. Thus, our results indicate that we accumulate aluminum in bone over our life span, but this does not seem to be of major pathogenetic significance for the occurrence of hip fracture or dementia.     

外展承重支架治疗Perthes病的临床观察和有限元分析

目的总结髋部外展支架治疗Perthes病的效果,分析其生物力学原理。方法用髋外展支架治疗214例、222髋儿童股骨头缺血性坏死,参照廖前德法按优、良、可、差4个等级评价治疗效果。建立股骨上段三维有限元模型,测定髋外展时股骨头内部和股骨颈的应力。结果所有病例经过2年以上的随访,优202髋,良18髋,可2髋。力学分析髋外展时,股骨头内部的应力逐渐缩小;股骨颈的内、外侧方的应力值则逐渐增大。结论用髋部外展支架治疗Perthes病是一种较好的方法,髋外展可改变应力由股骨头经股骨颈的传导。     

老年骨质疏松症对人工髋关节置换影响的实验研究

目的从生物力学角度探讨老年骨质疏松者对人工髋关节置换的影响及其治疗对策。方法采集30具新鲜股骨标本,DEXA骨密度仪测试每个标本干骺端、颈部、Ward三角区及大转子区的骨密度,将骨质疏松标本进行骨水泥和非骨水泥假体安装,测定其生物力学性能变化。结果老年骨质疏松程度的增加,假体置换后股骨上方应变呈增加的趋势。随着骨密度的增加,假体近端和远端微动随之减少,关节假体的初始稳定性显著增加。结论老年骨质疏松对人工关节假体的置换影响是明显的。老年骨质疏松患者采用骨水泥固定假体其松动率可下降30％～40％,临床上要求假体安装须精确匹配,骨水泥调制合理、厚度适中,以减少松动的发生率。     

髋关节骨性关节炎组织学计量与炎性因子表达

目的 探讨骨性关节炎各组织成分中细胞冈子、金属基质蛋白酶等炎性物质表达水平与疾病的关系.方法 获取行OA组关节置换及创伤性股骨颈骨折组患者手术时的软骨、滑膜组织和软骨下骨,苏木素-伊红(HE)染色行软骨下骨组织形态计量分析,应用放射免疫测定肿瘤坏死因子(TNF)-α与门细胞介素(IL)-1β,以酶联免疫吸附试验(ELISA)测金属基质蛋白酶(MMP)-9蛋白表达水平,并将两组结果进行t检验,软骨下骨组织计量值与细胞因子水平进行相关分析.结果 OA组较非OA对照组软骨下骨骨形成增加,骨质硬化骨小梁数目增加并错乱;滑膜组织中MMP-9表达是调;软骨组织中MMP-9及IL-1 β较对照组提高;而在软骨下骨,MMP-9、TNF-α及IL-β均有增高,并且与软骨下骨组织学改变相关联.结论 证实了OA促炎症条件的病理学基础,并且炎性改变与软骨硬化及关节软骨退变相关.     

复杂髋臼骨折早期结构重建的临床研究

目的：探讨复杂髋臼骨折结构重建的时机,为临床手术治疗提供准确的时间选择。方法：采用前瞻性随机对照试验的方法,将入院的复杂髋臼骨折患者分成试验组和对照组,其中试验组93例（96髋）,对照组98例（101髋）,试验组于伤后7d内完成手术,对照组于伤后10d后完成手术。用手术时间、术后复位的优良率、术后并发症、关节功能评定（疼痛行走、关节活动度）、SF-36等作为观察指标。结果：①试验组按各型骨折分类其所用的手术时间明显低于对照组。②按Matta关节功能和X线评定标准,试验组明显好于对照组。③在对术前、术后立即和术后半年的CT评定中,试验组的复位优良率明显高于对照组。结论：复杂髋臼骨折通过早期结构重建,能明显减少手术时间,增加手术复位率,减少并发症的发生．     

Secular trends in hip fracture incidence and recurrence

Summary  The decline in hip fracture incidence is now accompanied by a further reduction in the likelihood of a recurrent hip fracture among survivors of the first fracture. Introduction  Hip fracture incidence is declining in North America, but trends in hip fracture recurrence have not been described. Methods  All hip fracture events among Olmsted County, Minnesota residents in 1980–2006 were identified. Secular trends were assessed using Poisson regression, and predictors of recurrence were evaluated with Andersen–Gill time-to-fracture regression models. Results  Altogether, 2,752 hip fractures (median age, 83 years; 76% female) were observed, including 311 recurrences. Between 1980 and 2006, the incidence of a first-ever hip fracture declined by 1.37%/year for women (p < 0.001) and 0.06%/year for men (p = 0.917). Among 2,434 residents with a first-ever hip fracture, the cumulative incidence of a second hip fracture after 10 years was 11% in women and 6% in men with death treated as a competing risk. Age and calendar year of fracture were independently associated with hip fracture recurrence. Accounting for the reduction in first-ever hip fracture rates over time, hip fracture recurrence appeared to decline after 1997. Conclusion  A recent reduction in hip fracture recurrence is somewhat greater than expected from the declining incidence of hip fractures generally. Additional research is needed to determine the extent to which this can be attributed to improved patient management.     

生物型髋关节假体涂层脱落的临床分期和预防

目的:对于生物型髋关节长期的生物学效应是未知的.探讨生物型髋关节假体涂层脱落的原因和提出相应的预防和治疗措施具有重要临床意义.方法:自2002年10月至2009年2月,对5例生物型髋关节假体涂层脱落进行分析,采用全髋关节翻修术治疗.男3例,女2例;年龄55～68岁.术中取出假体进行分析,探讨涂层脱落发生的原因.对照组为翻修术取下的正常假体(10例).使用组织形态学观察断面的表面形态和微结构,并用电子数显外径千分尺测量碎片厚度,维式硬度计测量涂层的维式硬度(HV),以及Push-out试验测量界面抗剪切强度.对髋关节功能进行Harris评分.结果:对照组和试验组组织形态学观察有区别.2例HA涂层脱落患者涂层厚度分别为112、138μm;维氏硬度分别为5 843、4 524 Hv;抗剪切强度分别为12.4、11.6 MPa.3例钛珠涂层脱落患者术后Harris评分分别为82、88及87分.结论:多种原因可同时导致假体涂层脱落,但临床上碰到的涂层脱落的病例多与假体质量有关,现有各种方法可以明显提高涂层与假体之间的结合强度,从而预防涂层的早期脱落.